Carotid artery stenting in high-risk patients: immediate and short-term results

Aim
To review the immediate and short-term results of carotid artery stenting (CAS) in high-risk patients for surgery.
Patients and methods
This prospective study was carried out on 36 patients experiencing significant CAS. Patients were scheduled for CAS during the period between December 2015 and June 2018 and followed up for 1 year. All procedures were done in 6 October Insurance Hospital and Mahmoud Mosque Specialized Hospital. Most carotid lesions were internal carotid artery [33 (91.7%) patients], and only three (8.3%) patients had common carotid artery lesions. Overall, 31/36 patients had symptomatic carotid stenosis, whereas 5/36 patients were asymptomatic. The commonest presentation was stroke (58.3%) and transient ischemic attack (27.8%).
Results
Technical success was achieved in all patients. Embolic protection devices were used in all cases. Three (8.3%) patients developed stroke; two patients had intraoperative stroke after stent deployment and the other occurred during the 12-month follow-up. One (2.8%) patient developed cerebral hemorrhage. Six (16.7%) cases developed transient ischemic attack. Acute myocardial infarction occurred in three (8.3%) patients.
Conclusion
Management of CAS is challenging in high-risk patients. Stroke prevention is the main goal of successful treatment. Risk–benefit assessment should be based on patient status and procedural risk, rather than on the controversy between carotid endarterectomy and CAS.